A medical emergency can be frightening no matter what the circumstances, but female members of the Hasidic community have extra concerns when they’re in need of immediate assistance. Though the Jewish law of pikuach nefesh deems it religiously acceptable for a man to tend to a woman in an emergency since saving a life takes precedence over anything else, the patient still might be concerned about the rules of tznius, which refers to a wide swath of Jewish customs related to modesty and separation of the genders. Aside from the issue of religious observance, it can be personally embarrassing for an observant woman, who has been separated from men most of her life, to find her room filled with male EMTs–many of whom might be her neighbors and members of her community–when she’s in a physically and emotionally vulnerable position, such as going into labor.

Starting next month, after more than two years of planning, training, and fundraising, those concerns will be alleviated in the Orthodox enclave of Boro Park, Brooklyn. Now when those women call for medical assistance, they’ll be treated by Ezras Nashim, a corps of more than 20 EMT-certified Orthodox women on call to respond to their emergencies.

When a call comes in, Ezras Nashim will dispatch a female EMT, who will meet up with an ambulance to transport the patient to the nearest hospital. The EMT will remain with the patient as long as she desires, to ensure that she receives the medical care and religious consideration she needs, maintaining a level of tznius the women consider paramount to their community’s spiritual health.

“Tznius is as integral to the woman as Torah and Talmud study is to the man,” said Rachel Freier, the director of Ezras Nashim—which in Hebrew refers to the women’s section of a synagogue. “It is very important to our way of life, and it is not about women being second-class citizens or subjugated. When it comes to assisting in births, we are simply reclaiming our roles.”

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The origins of the idea behind Ezras Nashim stretch back decades. In the late 1960s, frustrated by long response times and what they saw as a lack of cultural sensitivity on the part of secular EMTs, Orthodox Jewish leaders in Williamsburg, Brooklyn, created their own volunteer-staffed emergency medical unit, which they called Hatzalah, Hebrew for “relief.” The goal of Hatzalah was to serve the medical-emergency needs of the burgeoning religious population in Brooklyn; EMTs spoke Yiddish and were halakhically knowledgeable. They knew when an injury was serious enough to warrant violating Shabbos, and they knew to take patients to hospitals that would be similarly sympathetic to their religious needs. Oftentimes, they remained at the hospital with patients to make sure their needs were being met and also that their religious values weren’t unwittingly compromised. Hatzalah in Williamsburg was so successful that branches began forming across the tri-state area, and eventually the world: Today, there are Hatzalah units not only in Israel and the United States, but in countries including Mexico, Australia, Switzerland, and England.

Yitzhok Shlomo Hoffman, a Ukrainian immigrant, was one of the nascent organization’s most enthusiastic champions and organizers. He believed a female branch of Hatzalah ought to be formed so that women could call on other women for help in an emergency. “It was about what is most comfortable for the patient,” a now wizened, white-bearded Hoffman told me recently. In the mid-1970s, he set up an EMT course in Williamsburg for women interested in learning emergency medicine. About 40 students paid $63 each to attend—including Hoffman’s daughter. She and her best friend, who wanted to be a nurse but felt that college wasn’t acceptable for a frum woman, enjoyed their course so much that they began to help train others, eventually moving up to Orange County, New York, to supervise the certification of around 70 women from the Hasidic community there. By 1981, some 300 women had been trained as EMTs or first responders, 225 of them in Williamsburg and Boro Park and 75 in Orange County. Plans for a women’s division of Hatzalah seemed to be coming to fruition.

But then a cadre of rabbis based in Williamsburg abruptly nixed the idea. Hoffman’s daughter and her friend believe that Hatzalah members expressed concerns to the rabbis that women serving alongside them as EMTs could initiate inappropriate gender interaction. Before the women knew it, their dreams of being active EMTs were squashed. Years passed, and though they and others like them used their medical training in other roles as camp or school nurses, they never fully abandoned their dreams of becoming active EMTs. One woman organized EMT classes at the religious girls’ school where she served as head nurse and principal, assuming the students would use their skills at camps or maybe when they had children of their own. Hoffman’s daughter kept all her meticulous grading notes on the students she taught in Orange County and Brooklyn and renewed her EMT license every 37 months as required for the next 30 years.

In January 2011, Barbara Bensoussan, a writer for the Orthodox magazine Mishpacha, interviewed five Orthodox women who were certified as EMTs at a home in Kensington, Brooklyn, for an article about female EMTs in the frum world. Because Mispacha is a Haredi publication, and thus editorially very careful not to criticize other Orthodox institutions, Bensoussan deftly avoided questioning the all-male policy that Hatzalah maintains or how it made the women present at the meeting feel. But even though the overarching tone of the article is a bit opaque, what comes through is that beneath their inoffensive, pious surfaces, these women were brewing with excitement and ideas, particularly regarding the concept of tznius; they also inadvertently revealed that they had bigger ambitions for themselves than posts as camp nurses. The conversation heated up when one interviewee mentioned an all-women’s corps in New Square, a tiny Rockland County town that is home to the Skver Hasidic sect. That group, then 12 women strong (it has around 24 members now), was organized as part of New Square Hatzalah by the rebbe there in 2009 to ensure that his female followers weren’t put into potentially uncomfortable situations with male first responders or EMTs. New Square is the only Jewish town to have a separate, all-female unit of Hatzalah.

“Maybe more communities should adopt this sort of approach,” a younger interviewee named Aliza is quoted as saying.

After the interview, Bensoussan remembered interviewing Freier for an article years earlier and gave one of the women Freier’s phone number, thinking she could help the Brooklyn group mobilize.

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Freier, a lawyer and Boro Park native, describes herself as a born advocate. When she was a child, her sisters would always run to her if something unjust happened. It’s not surprising, then, that she would gravitate toward the law, taking a job as a legal secretary after she graduated from high school. But much as being a camp nurse wasn’t enough for the women profiled in Mishpacha, being a paralegal wasn’t going to cut it for Freier. When her husband graduated from Touro College with a degree in accounting, she sat in the audience and applauded him, all the while thinking, “Now it’s my turn.” Soon after, she enrolled at Touro and went from there to Brooklyn Law School, during which time she gave birth to three of her six kids. She now practices real-estate law in Brooklyn and Monroe, New York, and also runs an organization called B’Derech, which counsels religious youth and often helps them pursue higher education.

“After I got involved in B’Derech,” she told State Assemblyman Dov Hikind while being interviewed on his radio show, “I kind of got this reputation of being a community activist.”

In June 2011, Freier met with the five women from the Mishpacha article. Taken by their story, she began an effort to convince Chevra Hatzalah, the board that oversees local Hatzalah groups, to absorb the women’s corps as a separate branch, but after many months of discussions, CEO Rabbi Dovid Cohen denied them admission, claiming the merger could cause a delay in Hatzalah’s response time. (Multiple representatives of Hatzalah declined to comment for this article, and Cohen has since resigned his position for unrelated reasons.) Though multiple Hatzalah members have voiced support for Ezras Nashim, they say they will not get involved in their operation, and so the women were left with no alternative and decided to mobilize as an independent entity.

By this time, Freier had started to feel the pull of emergency medicine. “I realized I couldn’t advocate for these women properly without becoming an EMT myself,” she told Voz Is Neias, an Orthodox news blog. She enrolled in EMT certification classes, even convincing her mother to join her. She and the other women started talking about formally organizing their own group, an emergency service for women, by women. The media started calling Freier, who began speaking out more often in public about the group’s goal, most often defending herself against the dreaded “F” word: feminist.

“I am not a feminist,” Freier told me. “In our community, being a feminist means you want to do what men do. I don’t think women should sing during prayer services, become rabbis, wear tallis, or have an aliyah. But women are natural nurturers who have been assisting in births since biblical Miriam! There is no halakha against women being midwives.”

Even with the indomitable Freier at the helm, the group has faced endless obstacles. There’s the ongoing issue of money: It costs $1,500 to take a certification course, and after that, each EMT needs to be individually insured. Then there’s the money for medical equipment—Epi-pens, oxygen tanks, automated external defibrillators, and so on. While women with licenses will take their own cars on calls, some volunteers don’t drive for modesty reasons; for them, there will be a “fly-car”—a car Ezras Nashim leases for this purpose—with a driver stationed outside their homes when they are on duty. If called, they will take the fly-car (outfitted with the requisite lights and sirens) to the site of the emergency, where they will be met by a contracted ambulance service for hospital transport, if necessary. Because of the cost and difficulty of securing licenses, they will contract with a local ambulance service as opposed to purchasing their own. (When Freier mentioned during a meeting the possibility of buying an ambulance in the future, a volunteer giddily asked, “Can we get a pink one?”) Aside from costs, there have been endless papers to file, bureaucratic bodies to convince, and certifications to earn. The group also faces internal difficulties, mostly related to organization. Sometimes even arranging a meeting is tough; because some of the women don’t use email, they often have to rely on regular mail and persistent phone calls to inform the members of an upcoming event.

Unlike secular services, though, Ezras Nashim has also had to face a skeptical community. In February 2012, after Freier formally announced plans for Ezras Nashim on Hikind’s radio show, the frum world buzzed with reactions, some supportive, but most skeptical. (“When we first talked about this on [my] show,” Hikind told me, “I thought, ‘Who’s going to be upset with this?’ Boy, was I wrong.”) No dissenters were willing to go on the record, but they were vocal about their disapproval on the Internet. “Women can call Ezras Nashim for the latest kugel recipe,” a commenter scoffed on a neighborhood news blog. In another, someone wrote, “I am sorry, but I see this endeavor as a waste of precious funds that should need to be used differently.” A majority of neighborhood women, however, seem cautiously optimistic. Brocha Dalfin of Crown Heights told me, “I feel the women who are part of this group have the knowledge and the calm that a woman needs when in a vulnerable state,” but then added that perhaps it might be best if they were absorbed into Hatzalah’s already strong infrastructure. Mrs. K of Boro Park, a mother of four grown children who preferred not to give her full name, said she supports the idea only “as long as it would be OK by rabbinical authority.” Ada Moseson, a longtime resident of the community and mother of four, thinks the enterprise is long overdue. “I think that the time for this organization has come quite a while ago and that while I respect Hatzalah for their superb service to the community, I think that there are certain areas that women would feel much more comfortable having Ezras Nashim take care of them under their circumstances, i.e., childbirth.” Others, like Hadassah Strauss, are so gung-ho that they’ve been inspired to sign up for training courses. “Since [labor] is an eis ratzon [favorable time to pray for the baby], it makes sense to me that we should have the highest standards of modesty during that time,” Strauss told me. “The mother should be as comfortable as possible so she can focus on what’s important, physically, emotionally, and spiritually.”

“I remember a lot of the initial reaction. Certain people were taken aback, but Ruchie Freier never stopped, moved ahead, covered her bases by speaking to the rabbis,” said Hikind, noting that “things have changed since then.”

Dr. Magdi Solomon lectures a class on vital signs at Bramson ORT.

None of the issues they’ve faced have been enough to deter Freier or her dedicated crew of nearly 50 volunteers. In fact, they went above and beyond, with each EMT attending additional training sessions at two local hospitals, where they shadowed doctors on the emergency and obstetrics wards, and obtaining certification in neo-natal resuscitation, which requires extra hours of instruction. New recruits are signing up every day, with 10 or so currently enrolled in courses. The EMTs will at first be answering calls related to childbirth but plan to expand their focus as they solidify their practice. During the summer, they plan to operate 24 hours a day during the week with a break on weekends—given that many of their clients and volunteers spend weekends outside the city—but in the fall Ezras Nashim will begin operating 24/seven.

Although Ezras Nashim will begin serving Boro Park, spilling over a bit into neighboring Kensington and Bensonhurst, depending on how the launch phase progresses, they hope to expand later into other neighborhoods in Brooklyn (Williamsburg, Crown Heights, Flatbush) and outside New York City (Long Island’s Five Towns, for instance, and Monsey in Orange County, New York). Freier has also started advising groups of women in Israel interested in starting their own ambulance corps. Filmmaker Paula Eiselt is trailing Freier and the crew for a documentary about them.

Despite the dissenters, costs, and headaches, Freier says it’s been worth it, especially to see so many women from varying backgrounds join together for the cause. She’s also been pleasantly surprised by how many people outside the Hasidic world have come out to laud their operation.

“A member of the health department told me recently, ‘I prayed for you women.’ A high-ranking official at the [Fire Department of New York] told me that if his daughter wanted to join, he would encourage her to. The support we have gotten is amazing.”

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Kelsey Osgood has contributed to The New Yorker, Time, and Salon, and is the author of the book How to Disappear Completely: On Modern Anorexia.